Refer a Patient: Gender Affirming Health Program

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For patients age 18 and up, see referral instructions below or refer through MD Link. Note the different instructions for surgical and non-surgical services.

For kids and teens, visit the Child and Adolescent Gender Care Center. For help referring international patients, contact International Services.

Gender-affirming primary care, hormone therapy and other non-surgical services

1. Download and complete our universal referral form:

Download referral form

2. Obtain insurance pre-authorization for the following visit codes: 99204, 99213 and 99214.

3. Fax the completed referral form and insurance authorization to:
(415) 353-3399
Attn: Dr. Maddie Deutsch

Gender-affirming surgical services

1. Download and complete our universal referral form:

Download referral form

2. Obtain insurance pre-authorization for visit codes 99245 and 99244, and for the following procedure CPT codes as appropriate:

• Bilateral Breast Augmentation: 19325, 19325-50
• Bilateral Mastectomy and Arreola Reconstruction (Top Surgery): 19303, 19403-50, 19350, 19350-50

3. Write a medical clearance letter for your patient. (Sample medical clearance letter.)

4. Fax the completed referral form, insurance authorization, and medical clearance letter to:
(415) 353-3399
Attn: Gender Affirming Health Program navigator